Adherence is defined as ‘the extent to which a person’s behaviour coincides with medical or health advice’. Non-adherence to therapeutic regimens is a common and expensive problem in patients with chronic diseases including systemic lupus erythematosus (SLE) and is associated with a higher risk of flares, morbidity, hospitalisations and poor renal outcomes.1 2 Non-adherence is also very difficult to evaluate.3–5
Hydroxychloroquine (HCQ), an important medication in SLE with an excellent benefit:risk ratio, has a long half-life and it can be measured in blood. Undetectable or very low levels of blood HCQ is then a simple, objective and reliable marker of non-adherence in SLE patients.1 4 5
Levels of HCQ and then HCQ non-adherence should be routinely and repeatedly assessed. If severe non-adherence is unmasked, a non-judgmental and open discussion must take place to improve adherence as much as possible. This task is not simple, but particularly important and some tips will be discussed (table 1).5
Costedoat-Chalumeau N, et al. Adherence to treatment in systemic lupus erythematosus patients. Best Pract Res Clin Rheumatol 2013 Jun;27(3):329–340.
Feldman CH, et al. Medication nonadherence is associated with increased subsequent acute care utilization among medicaid beneficiaries with systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2015 Dec;67(12):1712–1721.
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005 Aug 4;353(5):487–497.
Costedoat-Chalumeau N, et al. A prospective international study on adherence to treatment in 305 patients with flaring SLE: assessment by drug levels and self-administered questionnaires. Clin Pharmacol Ther 2019 Aug;106(2):374–382.
Costedoat-Chalumeau N, Houssiau FA. Improving medication adherence in patients with lupus nephritis. Kidney Int 2021 Feb;99(2):285–287.
Recognise the frequency and consequences of non-adherence
Describe methods to evaluate non-adherence
Analyse blood hydroxychloroquine levels
Improve the way we discuss non-adherence with our patients
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